# Swiss electronic patient file: connect the FHIR CH EPR API

> DEP FHIR Implementation Guide: CH EPR FHIR 5.0.0, EPR-SPID identifier, MHD / PIXm / PDQm transactions, languageCode metadata, and what is prohibited from storing.

Author: Ala Ben Aicha

Canonical page: https://alabenaicha.me/insights/swiss-patient-dossier-fhir-api

Updated: 2026-09-17

## Direct answer

The Swiss DEP remains operational. The FHIR API to pin is CH EPR FHIR 5.0.0. The national identifier is the EPR-SPID (OID 2.16.756.5.30.1.127.3.10.3). A generic FHIR server is not a DEP connection.

## FHIR first, SOAP next

The English page [Swiss EPD integration](https://alabenaicha.me/insights/swiss-electronic-patient-dossier-integration) describes the historical IHE contract (XDS.b, PIX/PDQ V3, XUA). **This is the FHIR contract** published by eHealth Switzerland: [CH EPR FHIR (R4) 5.0.0](https://fhir.ch/ig/ch-epr-fhir/) (DSTU 5 Ballot 1, current published version, active as of December 18, 2025). Official URL: `http://fhir.ch/ig/ch-epr-fhir/ImplementationGuide/ch.fhir.ig.ch-epr-fhir`. Package: `ch.fhir.ig.ch-epr-fhir#5.0.0` on FHIR R4.0.1.

The DEP remains a **federated system of communities**. A patient has a community of reference; documents may also be published elsewhere. The E-GD reform is not, on its own, a production API. Check the [operating status](https://www.e-health-suisse.ch/fr/le-dep/dossier-electronique-du-patient/exploitation-developpement) and the[architecture](https://www.e-health-suisse.ch/fr/technique/interoperabilite-technique/architecture-dep-suisse) of the chosen community (in French-speaking Switzerland, often CARA — to be confirmed in the onboarding contract, not through a blog).

Order: [ODEP, RS 816.11](https://www.admin.ch/opc/fr/classified-compilation/20111795/index.html). The IG explicitly says that it should be read with the IHE ITI volumes.

## The identifier that is not stored in the registry

Each patient has **an active EPR-SPID**. CH Core profiles it as [EPR-SPID Identifier](https://fhir.ch/ig/ch-core/StructureDefinition-ch-core-epr-spid-identifier.html) : `identifier.system` fixed at `urn:oid:2.16.756.5.30.1.127.3.10.3`. Profile Constraints: Value starts with `76133761`, 18 digits, modulo 10 control.

**There is no national addressable Patient resource.** The patient references are logical (EPR-SPID identifier), hence PIXm and PDQm `$match` rather than MHDS/PMIR. The systems **are not authorized to store the EPR-SPID** in document deposits or registers: the IG refers to art. 10 para. 3 ODEP-DFI (RS 816.111). You feed a `localID` + EPR-SPID to the community to resolve later; you do not write the EPR-SPID in the persisted XDS/MHD metadata.

Professionals are identified by **GLN**, also in logical reference (not a `Practitioner.id` national).

Don't invent a "valid" EPR-SPID in your captures. The pattern and modulo 10 are sufficient for a validator test; a value that passes the checksum is not necessarily a public fixture identifier.

## MHD Transactions (and National Extension)

| Transaction                | Code                     | Resource/operation                                                         | XDS.b equivalent       | Trap                                                                                                    |
| -------------------------- | ------------------------ | -------------------------------------------------------------------------- | ---------------------- | ------------------------------------------------------------------------------------------------------- |
| Provide Document Bundle    | **ITI-65**               | `POST` Bundle transaction: `DocumentReference` + `Binary` (+SubmissionSet) | ITI-41                 | Patient = logical EPR-SPID identifier, resources *contained* for local demographics                     |
| Find Document References   | **ITI-67**               | `GET /DocumentReference`                                                   | ITI-18                 | Filter without `languageCode` in French-speaking Switzerland = documents not found on the business side |
| Retrieve Document          | **ITI-68**               | `GET /Binary/{id}`                                                         | ITI-43                 | It's not a `Composition` REST                                                                           |
| Update Document Metadata   | **CH:MHD-1**             | National extension CH EPR FHIR                                             | (not in basic MHD IHE) | A generic FHIR PATCH is not CH:MHD-1                                                                    |
| PIXm Identity Feed / Query | **ITI-104** / **ITI-83** | Feed Patient ; query identifiers                                           | PIX V3 ITI-44/45       | Store the EPR-SPID in the registry                                                                      |
| PDQm `$match`              | **ITI-119**              | `Parameters` in/out                                                        | PDQ V3 ITI-47          | A `GET /Patient?name=` national                                                                         |

`languageCode` is not cosmetic. The Swiss eHealth codesystem (`ch-ehealth-codesystem-language`) covers German, French, Italian and Romansh. A document published without language, or with `en` by framework default, breaks patient views and metadata controls.

AuthN/AuthZ: the IG separates **customer** (message signing or mTLS) and **user** (SAML 2.0 or OpenID Connect JWT according to ODEP-DFI Annex 8), with IUA. A “SMART sandbox” Bearer token is not a DEP assertion.

National profiles in the same GI: **CH:PPQm** (consent policies) and **CH:ATC** (patient audit trail). An MHD who ignores PPQm publishes in the legal void of the file.

## Community checklist, not an eHealth Switzerland certificate

1. **Community Interface Agreement** (actually exposed transactions, IG version, test environment, certificates). A published GI ≠ a production endpoint.
2. **CapabilityStatement** actors MHD Document Source / Consumer / Recipient / Responder **CH**, plus PIXm/PDQm.
3. **Fixtures** : Bundle ITI-65 de-identified, `languageCode=fr`, GLN author, no EPR-SPID in Binary/registry.
4. **Refusal of access and emergency** :403/policy deny, audited emergency access (CH:ATC), not a silent retry.
5. **SOAP in parallel.** Many communities still expose XDS.b. See the [IHE page](https://alabenaicha.me/insights/ihe-profiles-european-healthcare-integration) and the article [C-CDA / documents](https://alabenaicha.me/insights/c-cda-to-fhir-document-exchange). MHD is not a magic substitute.

## What this page is not

This is not a community certification, not a CARA or AD Swiss onboarding, not an opinion on E-GD, not legal or clinical advice. Implementing CH EPR FHIR 5.0.0 in a lab does not allow you to write “connected to DEP” on a placard. I do not represent eHealth Suisse or a community.

If you need MHD/PIXm cabling on an existing IS, this is [interoperability in digital health](https://alabenaicha.me/services/digital-health-interoperability). For a bounded spike, use the [contact with project intention](https://alabenaicha.me/contact?intent=project).